The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports

Opioid medications are the most commonly prescribed medications for the treatment of chronic non-cancer pain.  However, the side effects and risks of addiction often prevent problems with patients with long term use of opioids.  In particular, opioid-induced constipation (OIC) is one of the most common side effects that impact patient quality of life, with patient surveys suggesting that as many as 17-67% of opioid patients experiencing GI immobility while on the medication.  Although this is a commonly recognized issue related to opioid therapy, there appears to be a lack of communication between patients and physicians about treatment and the role it plays in patient quality of life.

A recent study published on behalf of AstraZeneca Pharmaceuticals attempted to look at the prevalence of OIC, and the differences in patient and provider perception of the issue.  The researchers performed a perspective, longitudinal cohort study on 489 patients being treated with opioids for chronic pain in the U.S, Canada, U.K., and Germany.  Patients were selected based on chronic pain conditions that would be treated for >6 months, diagnosed with OIC based on patient reported symptoms.  Both patients and health care providers were asked to complete online surveys to assess their experience with OIC, quality of life, treatment options, concerns, and patient-provider interaction.

The results of the study showed that most providers reported discussing the potential for OIC and its impact on the patients medication experience.  However, just over half of patients reported disclosing instances of OIC with their doctor.  Most patients took OTC laxatives to cope with the OIC, and many reported lower quality of life.  Some patients reported lowering their opioid dose to alleviate OIC symptoms, but reported a corresponding increase in their level of chronic pain.  There was a reported lack of communication between patients and providers about the problem, with both sides reporting confusion over who was the anticipated initiator of the conversation.  There was also a lack of understanding from patients in available options for OIC treatment, as well as provider reported differences in priority of OIC between patients and their physicians.  The study concluded that there is a noticeable rift between patients and their providers over the perceived impact that OIC has on pain management.  They believe that an increase in communication related to opioid side effects, and resolution discussions will help lower patient anxiety over symptoms and increase quality of life without sacrificing pain management.

This problem clearly highlights some of the issues that still plague the pain management care field.  Clearly there is a communication issue between patients and their doctors that needs to be resolved in order to reduce OIC incidence and impact on pain therapy.  As pharmacists, we have an opportunity to address concerns with OIC, offer medication treatment options, and open dialogue between the patients and their primary care physicians.  Is this an area that pharmacists should prioritize in patient care? If so what options are there for getting more involved in opioid therapy and the risk of OIC?

Article Link

Locasale, Robert. Datto, Catherine. Wilson, Hilary. Yeomans, Karen. Coyne, Karin. The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports. J Manag Care Spec Pharm. 2016; 22 (3): 236-245.

2 thoughts on “The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports”

  1. I think the OIC is a window to the amount of problems included with communication about prescription medications. Patients getting prescribed opioids who experience constipation may have an embarrassment factor for not asking about it, or they may not even know about OIC. I agree that pharmacists need to take action as the middle man between the physician and the patient. Patients will most likely not want to discuss this in an open community pharmacy setting. If not already available, there should be a brief mandatory counseling session about opioid use for chronic pain. This could be a discussion between the physician and patient in which adverse effects are explained, and a pharmacist could assist in detailing what other therapies may be used to treat or prevent the adverse effects. I believe that patients should have a comfortable setting in which they can talk with their healthcare providers about their concerns. The pharmacist and the physician should know how to ask the correct questions so the patient feels comfortable enough to disclose the information at the start of the therapy.

  2. I think pharmacists can certainly play a huge role in bridging this patient care and drug therapy gap. A patient-pharmacist interaction serves as a kind of second line of information and counseling about preventing and treating OIC. OIC clearly affects a patient’s day to day life and pain management. Pharmacists have the ability to both make sure patients are aware of this side effect and give an OTC laxative right there during the interaction. In my opinion, I can see patients communication with pharmacists being more open to start this dialogue vs. with their physicians when initially being prescribed.

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